XYZ Life is the insurer in respect of a group insurance arrangement. It is important that you have read and understood the current Product Disclosure Statement for the cover for which you are applying.

You are requested to complete this form if one of the following applies to you:

you are proposing to become an insured member under the policy and your benefits are subject to assessment by XYZ Life

you are an existing insured member and your benefit (or part thereof) is subject to assessment by XYZ Life.

XYZ Life requires this Personal Statement and other health information to assist us in making a decision on your proposed insurance cover. This Personal Statement is confidential. Please refer to the Privacy Statement in the Product Disclosure Statement.

Important notice

XYZ Life is the insurer in respect of a group insurance arrangement. It is important that you have read and understood the current Product Disclosure Statement for the cover for which you are applying.

You are requested to complete this form if one of the following applies to you:

you are proposing to become an insured member under the policy and your benefits are subject to assessment by XYZ Life

you are an existing insured member and your benefit (or part thereof) is subject to assessment by XYZ Life.

XYZ Life requires this Personal Statement and other health information to assist us in making a decision on your proposed insurance cover. This Personal Statement is confidential. Please refer to the Privacy Statement in the Product Disclosure Statement.